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Ongoing Care 1.Assess patient and care given by individuals at scene before you arrived. 2.Continue or, if necessary, correct any care given. 3.Follow EMS system protocols for assessment and care. Contact dispatch for assistance and to report on situation.

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Care during assessment 1.Some injuries may need immediate care. Certain soft-tissue injuries may be cared for as you assess patient. 2.Follow local protocols, and remember that many soft-tissue injuries are low priority.

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Care of closed wounds 1.Bruises are most frequently seen and do not require emergency care. 2.Large bruises may indicate serious bleeding. Swelling and deformity of bruise site may indicate underlying fractures. 3.A rigid abdomen and coughing up blood may indicate serious internal bleeding. 4.Generally, First Responder treatment will be to provide care for shock.

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Care of opened wounds 1.Expose wound-carefully cut clothing away from wound site. 2.Clear wound surface-gently brush away foreign matter without scrubbing site and creating more bleeding. 3.Control bleeding-start with direct pressure, elevate as necessary, use pressure point if bleeding cannot be controlled, and a tourniquet as a last resort. Do not remove dressing once it is in place. 4.Prevent further contamination-dress wound with a sterile or clean dressing or cloth, and secure in place with a bandage. 5.Keep patient lying still, since activity increases bleeding. Cover to keep patient warm (shock care), and protect from the elements. 6.Reassure patient to reduce anxiety, movement, and blood pressure. 7.Care for shock (hypoperfusion) for any patient with any wound. Do not elevate a limb if there is a possibility of fracture.

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Care for specific injuries – Puncture wounds a.Assume there is internal bleeding, look for an exit wound, and care for both. b.Provide care 1)DO NOT remove impaled objects. 2)Expose wound. Cut clothing from around object without disturbing it. 3)Control bleeding by direct hand pressure around wound site. 4)Stabilize object by stacking bulky dressings around it, alternating direction of each layer and securing them in place with tape or cravats. 5)Keep patient at rest and reassured. 6)Provide care for shock. Do not elevate legs if object is in leg, abdomen, or pelvis.

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Avulsions a.For loose flaps of skin: 1)Clear surface of wound. 2)Gently fold skin back to its normal position. 3)Control bleeding and provide care as for any open wound using bulky dressing. b.For skin or another body part torn from body: 1)Care for wound with bulky pressure dressings. 2)Preserve avulsed part-wrap it and keep it cool, but do not place in direct contact with ice.

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Amputations a.Care for wound with bulky pressure dressings. b.If bleeding continues, use a pressure point. Apply a tourniquet only as a last resort. c.Wrap or bag amputated part, and keep it cool.

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Protruding Organs a.DO NOT try to replace organs. b.Place a plastic covering over exposed organs to conserve moisture and then a layer of thick pads or dressing to conserve heat. Secure gently in place with cravats. c.Provide care for shock, and do not give patient anything by mouth.

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Scalp Injuries a.DO NOT attempt to clean the surface of a scalp wound. This will cause more bleeding and more damage if there is an underlying skull fracture. b.DO NOT apply finger pressure if there is a chance of skull fracture. c.May remove an impaled object from cheek if it has penetrated cheek wall and will obstruct airway. d.Control bleeding with a bulky dressing, and carefully control pressure applied. e.Secure dressing with a roller bandage, triangular bandage, or cravat. f. If there are no signs of skull fracture or injuries to spine, neck, or chest, position patient so that head and shoulders are slightly elevated.

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Facial Wounds a.Make certain airway is open and breathing is adequate. b.Correct breathing problems as you stabilize head and neck in case of spinal injuries. c.Control bleeding by controlled direct pressure in case there are underlying fractures. d.Apply a dressing and bandage.

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Impaled object in cheek a.Look in mouth and probe to see if object penetrated cheek wall. b.Carefully pull or push the object out of cheek wall back in direction that it entered cheek. c.Place a dressing inside cheek, and monitor so it does not obstruct airway. d.If object cannot be removed, stabilize it in place with bulky dressings on the outside of cheek. e.Position patient so blood and fluids drain from mouth. f.If spinal injuries, place dressing material inside cheek to control blood flow. g.Dress and bandage outside of wound.

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Eye Injuries a.General 1)DO NOT remove impaled objects. 2)DO NOT place avulsed eye back into its socket. 3)DO NOT apply direct pressure to a cut eyeball. 4)DO NOT probe into eye socket. b.Foreign matter 1)Flush by flowing water from corner across surface of eye; hold patient's lids open. 2)Do not flush if eyeball is cut or if there is an impaled object. 3)Cover both patient's eyes to reduce eye movement and discomfort.

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Impaled Object 1)Place several layers of dressings or small roller gauze on each side of object. 2)Place a cardboard cup over object and rest it on top of the pad. 3)Secure pad and cup in place with roller bandage. 4)Cover uninjured eye, and secure dressing in place. 5)Care for shock, and provide emotional support to patient.

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Nose Injuries a.Maintain an open airway, and stop bleeding. b.For conscious patient 1)Sit him forward to prevent blood from draining down throat, which causes nausea and vomiting. 2)Pinch nostrils; DO NOT pack them. c.For unconscious patient 1)Elevate head slightly or place patient on one side for drainage (no spinal injuries suspected). 2)Pinch the nostrils. d.Fluids draining from the nose 1)May indicate skull fracture. 2)DO NOT pack the nose. 3)Apply loose dressing. e.Foreign objects 1)DO NOT remove or probe nostrils. 2)DO NOT allow patient to blow his nose while bleeding or after controlling a recent bleed. f.Avulsions 1)Apply pressure dressing to site. 2)Wrap and save avulsed part, and keep it cool.

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Injury to the Mouth a.Assure airway is open and breathing is adequate. b.If there is no suspected spinal injury, sit patient forward for drainage or position on one side with head downward for drainage. c.Cut lips-place rolled or folded dressing between lip and gum. d.Avulsed lips 1)Apply pressure bandage to site. 2)Wrap and save part, and keep it cool. e.Cuts to internal cheek 1)DO NOT pack mouth. 2)Place dressing between cheek and gum; hold in place with gloved hand.

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Neck wounds a.Signs 1)Difficulty speaking, loss of voice 2)Airway obstruction when mouth and nose are clear (due to swollen tissues) 3)Obvious swelling or bruising of neck 4)Tracheal deviation (windpipe pushed off to one side) 5)Depressions in neck 6)Obvious cuts or puncture wounds b.Care for profuse bleeding from arteries 1)Immediately apply direct pressure with palm of your gloved hand. 2)Apply a pressure dressing, but DO NOT apply pressure to airway or to both sides of neck at once. 3)Once bleeding is controlled, place patient on left side and, if possible, in a slight head- down slant. 4)Provide care for shock. c.Care for profuse bleeding from veins 1)Immediately apply direct pressure with palm of your gloved hand. 2)Apply an occlusive dressing, and secure on all sides with tape. 3)Position patient on his left side and, if possible, in a slight head-down slant. 4)Provide care for shock.

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Abdominal Injuries a.Signs of abdominal injuries 1)Deep cuts or puncture wounds to abdomen, pelvis, lower back 2)Indications of blunt trauma to abdomen or pelvis 3)Pain or cramps in abdominopelvic region 4)Patient is protecting or guarding abdomen. 5)Patient is lying still with legs drawn up to chest. 6)Rapid, shallow breathing, rapid pulse 7)Rigid and/or tender abdomen b.Emergency care 1)Dress all open wounds. 2)Position patient on his back with legs flexed if there are no signs of injury to pelvis or lower limbs. 3)Care for shock. 4)Be alert for vomiting. 5)Be certain that you do not touch any exposed internal organs; cover them with occlusive dressing, such as plastic wrap, and then bulky dressings to maintain warmth.

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Injury to the genitalia a.Types of injuries 1)Blunt trauma injury-usually painful and can be relieved by an ice pack wrapped in a towel placed on site. 2)Cuts-bleeding can be controlled with direct pressure and application of a bulky dressing held in place with triangular bandage. b.Other care 1)DO NOT remove impaled objects. 2)Save and wrap avulsed parts, and keep them cool. 3)Conduct all care procedures as you would for an injury to any other part of the body.